Quality of care for major depression and its determinants: a multilevel analysis.
Quality of care for major depression and its determinants: a multilevel analysis.
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DOI：
10.1186/1471-244x-12-142
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发表时间：
2012-09-17
期刊：
影响因子：
4.4
通讯作者：
Roberge P
中科院分区：
文献类型：
--
作者：
Duhoux A;Fournier L;Gauvin L;Roberge P
许多研究强调了初级保健中抑郁症护理质量的重要差距。但是，经常使用基本指标。这些研究很少审查与接受适当治疗有关的因素，特别是同时考虑到个人和组织的特点。本研究的目的是估计接受适当治疗的重度抑郁发作（MDE）初级保健患者的比例，并检查与接受至少一种最低限度适当治疗的抑郁症相关的个人和组织（即临床水平）特征。本研究使用的样本包括915名咨询全科医生（GP）的成年人，无论咨询动机如何，在调查前12个月内（T1）符合DSM-IV的MDE标准，并在65个初级保健诊所内。本研究报告的数据来自“对话”项目。对27项质量指标的依从率进行了估计，这些指标被选择用于涵盖抑郁症治疗的最重要组成部分。进行了多水平分析。在被测量的质量指标中，三分之一对指导方针的依从性很高（bbb75 %），但在近一半的测量中，指导方针的依从性很低（<60%）。超过一半的样本（52.2%）接受了至少一种最低限度的抑郁症治疗。在个人层面，决定接受最低限度适当护理的因素包括年龄、是否有家庭医生、是否有补充保险、是否患有共病焦虑症和抑郁症的严重程度。在诊所层面，决定因素包括现场心理治疗的可用性、治疗算法的使用和报酬模式。我们的研究结果表明，需要采取干预措施，以提高初级精神卫生保健符合循证建议的程度。这些干预措施应针对特定人群（即年轻人和老年人），提高心理治疗和常规家庭医生的可及性，并以不同方式支持初级保健医生对抑郁症患者的临床实践，如发展治疗抑郁症的知识和调整报酬模式。
Numerous studies highlight an important gap in the quality of care for depression in primary care. However, basic indicators were often used. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The purpose of this study was to estimate the proportion of primary care patients with a major depressive episode (MDE) who receive adequate treatment and to examine the individual and organizational (i.e., clinic-level) characteristics associated with the receipt of at least one minimally adequate treatment for depression. The sample used for this study included 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for MDE during the 12 months preceding the survey (T1), and nested within 65 primary care clinics. Data reported in this study were obtained from the “Dialogue” project. Adherence rates for 27 quality indicators selected to cover the most important components of depression treatment were estimated. Multilevel analyses were conducted. Adherence to guidelines was high (>75%) for one third of the quality indicators that were measured but was low (<60%) for nearly half of the measures. Just over half of the sample (52.2%) received at least one minimally adequate treatment for depression. At the individual level, determinants of receipt of minimally adequate care included age, having a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and the severity of depression. At the clinic level, determinants included the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration. Our findings suggest that interventions are needed to increase the extent to which primary mental health care conforms to evidence-based recommendations. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration.